Mount Carmel Health Partners Clinical Guidelines Diabetes Type II - Page 2

Diagnosis Treatment (continue…) • HbA1c greater than or equal to 6.5%  If patients with inadequate diabetic controlled and are overweight consider metabolic Surgery. - BMI (body mass index) ≥40 kg/m² (BMI ≥37.5 kg/m² in Asian Americans) - BMI 35 to 39 kg/m² (BMI 32.5 to 37.4 kg/m² in Asian Americans) when hyperglycemia is inadequately controlled by lifestyle measures and optimal medical therapy OR • Fasting plasma glucose (FPG) greater than or equal to 126 mg/dL OR • 2-hour glucose tolerance test (GTT) greater than or equal to 200 mg/dL OR • Two random blood glucose measurements 200mg/dL greater than 200 mg/dL (second test for confirmation) Evaluation  Assess risk factors, comorbidities, and identifiable causes of Risk Factors hyperglycemia  Conduct a comprehensive history and physical  Obtain tests: urinalysis, fasting blood glucose, HbA1c, and renal Intrinsic • Age greater than 45 • Ethnic origin/race • History of hypertension or cardiovascular disease • Polycystic ovary syndrome • History of gestational diabetes; baby over 9 lbs.  Family history of diabetes  Metabolic syndrome function panel with GFR, microalbuminuria  Identify and treat appropriate additional comorbid conditions: - Hypertension - Dyslipidemia - Cardiovascular disease - Depression - Disordered eating behaviors  Assess for metabolic syndrome Extrinsic • Excess body weight (BMI greater than 25) • Pre-diabetes diagnosis • Diet (saturated fats and refined sugars) • Physical inactivity • Heavy alcohol use (more than two drinks/day) • Tobacco use Annual Tests       Treatment • Appropriate history and physical exam upon diagnosis. • Monitor HbA1c twice yearly for those meeting treatment goals. • Monitor HbA1c quarterly for those not meeting treatment goals. • Treat to desired goal of HbA1c less than 7 percent ¹ • Emphasis on lifestyle modification as the foundation, with medication added when treatment goal otherwise not met. • Review self-management of finger-stick blood sugar monitoring. • Reinforce lifestyle modification (such as diet, exercise, and smoking cessation). • Assess compliance to therapy. • Positive microalbuminuria screen is treated with ACE/ARB pharmacological therapy.  American Diabetes Association recommends a blood pressure goal of 140/80.  Moderate-high intensity statin therapy should be added to lifestyle therapy, regardless of baseline lipid levels, for patients with diabetes: - with overt ASCVD - without ASCVD and have one or more other ASCVD risk factors (family history of ASCVD, hypertension, smoking, dyslipidemia, or albuminuria).  For low-risk patients who are over the age of 40 years, moderate- intensity statin therapy should be considered in addition to lifestyle therapy.  Daily low-dose aspirin therapy is recommended as a primary prevention in men and women ≥50 years old with at least one ASCV risk factor and as secondary prevention in all patients with diabetes and history of ASCVD. If contraindicated, clopidogrel or ticlopidine are suitable a